tailieunhanh - Managing drug resistant tuberculosis

Antituberculosis drug resistance is increasing both in the United Kingdom and It has come to greater public attention with the emergence of extensively drug resistant tuberculosis (box 1) in South Africa, where an outbreak proved rapidly fatal among people with advanced HIV In this article we review recent global and UK trends in drug resistant tuberculosis and summarise its diagnosis, treatment, and control. Few data are available from randomised controlled trials to guide treatment of drug resistant tuberculosis, and none for multidrug resistant tuberculosis; this review is based primarily on data from observational epidemiological studies and on national and international guidelines. How did we get to where we are? Writing in this journal. | CLINICAL REVIEW For the full versions of these articles see Managing drug resistant tuberculosis Alison Grant 1 2 Philip Gothard 1 Guy Thwaites1 3 PRACTICE p 573 1Hospital for Tropical Diseases University College London Hospitals NHS Foundation Trust London WC1E 6JB 2Clinical Research Unit London School of Hygiene Tropical Medicine London WC1E 7HT 3Centre for Molecular Microbiology and Infection Imperial College London sW7 2AZ _ Correspondence to A Grant Cite this as BMJ 2008 337 a1110 doi Antituberculosis drug resistance is increasing both in the United Kingdom and It has come to greater public attention with the emergence of extensively drug resistant tuberculosis box 1 in South Africa where an outbreak proved rapidly fatal among people with advanced HIV In this article we review recent global and UK trends in drug resistant tuberculosis and summarise its diagnosis treatment and control. Few data are available from randomised controlled trials to guide treatment of drug resistant tuberculosis and none for multidrug resistant tuberculosis this review is based primarily on data from observational epidemiological studies and on national and international guidelines. How did we get to where we are Writing in this journal 60 years ago Bradford Hill reported that although two thirds of patients with advanced pulmonary tuberculosis improved with streptomycin monotherapy within six months 35 of 41 patients had developed streptomycin Combining streptomycin with isoniazid and paraaminosalicylic acid limited the evolution of resistance but treatment for one to two years was needed and excellent clinical trial outcomes were difficult to reproduce in programmes with limited resources for supervised drug Clinical trials from 1970 that used regimens containing rifampicin showed that treatment could safely be shortened to six months